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PMID: 21775111
Nutr Metab Cardiovasc Dis. 2011 Jul 18. [Epub ahead of print]
Impact of overweight and obesity on cardiac benefit of antihypertensive treatment.
Gerdts E, de Simone G, Lund BP, Okin PM, Wachtell K, Boman K, Nieminen MS, Dahlöf B, Devereux RB.
Source
Institute of Medicine, University of Bergen, and Department of Heart Disease, Haukeland University Hospital, N-5021, Bergen,
Norway.
Abstract
BACKGROUND AND AIMS:
Increased body mass index (BMI) has been associated with increased cardiovascular morbidity and mortality in
hypertension. Less is known about the impact of BMI on improvement in left ventricular (LV) structure and function during
antihypertensive treatment.
METHODS AND RESULTS:
Annual BMI, echocardiograms and cardiovascular events were recorded in 875 hypertensive patients with LV
hypertrophy during 4.8 years randomized treatment in the Losartan Intervention For Endpoint reduction in hypertension
(LIFE) echocardiography substudy. Patients were grouped by baseline BMI into normal (n = 282), overweight (n = 405),
obese (n = 150) and severely obese groups (n = 38) (BMI ≤24.9, 25.0-29.9, 30.0-34.9, and ≥35.0 kg/m(2), respectively).
At study end, residual LV hypertrophy was present in 54% of obese and 79% of severely obese patients compared to
31% of normal weight patients (both p < 0.01). In regression analyses, adjusting for initial LV mass/height(2.7), higher
BMI predicted less LV hypertrophy reduction and more reduction in LV ejection fraction (both p < 0.05), independent of
blood pressure reduction, diabetes and in-study weight change. During follow-up, 91 patients suffered cardiovascular
death, myocardial infarction or stroke. In Cox regression analysis 1 kg/m(2) higher baseline BMI predicted a 5% higher
rate of cardiovascular events and 10% higher cardiovascular mortality over 4.8 years (both p < 0.05).
CONCLUSIONS:
In hypertensive patients in the LIFE study, increased BMI was associated with less reduction of LV hypertrophy and less
improvement in LV systolic function which may contribute to the observed higher cardiovascular event rate of treated
hypertensive patients.